Provider Demographics
NPI:1801368881
Name:ROSENBAUM, YITZCHOK TZVI (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:YITZCHOK
Middle Name:TZVI
Last Name:ROSENBAUM
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4357
Mailing Address - Country:US
Mailing Address - Phone:801-882-8789
Mailing Address - Fax:
Practice Address - Street 1:3397 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4357
Practice Address - Country:US
Practice Address - Phone:801-882-8789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant